Practice Management Alert

Question: I don’t understand what the acronym MUE means in relation to the Centers for Medicare & Medicaid Services. What does it stand for?

Maryland Subscriber

Answer: The Centers for Medicare & Medicaid Services (CMS) defines MUEs as “medically unlikely edits.”

Specifically, CMS says: “An MUE is a unit of service edit for a Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT^®) code for services rendered by a single provider/supplier to a single beneficiary on the same date of service. The ideal MUE is the maximum unit(s) of service that would be reported for a HCPCS/CPT^® code on the vast majority of appropriately reported claims. MUEs are adjudicated either as claim line edits or date of service edits.”

The program was developed to reduce the paid claims error rate for Medicare claims, CMS says, especially surrounding clerical entry errors and incorrect coding due to anatomy, HCPCS/CPT^® code descriptors, CPT^® coding instructions, CMS policies, and the nature of an analyte or equipment or prescribing information, as well as claims data.